060816 DUPLICATE WARRANTS - 4.PDF

INTEROFFICE MEMORANDUM
gkfaricopa County School . Superintendent's 0_
TO: CLERX OE TOE 00AR (1)
FROM: Iliffie 'Thompson
SUBJECT: Affidavits
DATE: 5/13/2016
Pase _find attached 1 Affidavit/Arotice of Claim(s)for lost warrants for inclusion on
the net available Ooard agenda
'The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previously re-issued
'The original warrant (s) have had a stop payment done.
If you have any questions, please contact 911iCrie Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School - Finance Division at 4041 N: Central-Avenue #1200, ( 12 th
Floor) Thankyou.
#44 AVONDALE SALLTASTON . $38.69
RECE
MAY 1 6 2016
MANCOPA COUNTY
CLERK BoAl:T C SUPERVISORS
Afica

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
MARICOPA COUNTY
R7ADN being duly sworn, upon oath deposes and says:
h
That on the .CA day Of WN\R. )-0 ¶5 he/she presented to
the Avondale Elementary School District of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of , ¶5 , said claim being the
sum of (1)(4 (CO dollars ($ (0q ) in payment of which the
Superintendent of Schools caused his/her Warrant Number tS 4-1;\ to be issued on
sj JJN pj , , drawn on the Fund of Avondale Elementary School District of
Maricopa County, Arizona.
Claimant further says that although he/she was informed and believed that the above-
mentioned warrant was regularly issued, the same has never been received or has been lost. Under
penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due
and owing.
Wherefore, claimant requests that the Board of Supervisors order and in the Superintendent
of Schools issue him/her a duplicate of Warrant Number k 5 00C\ 31A in the sum of
$ '10Ci
Claimant Signature _ALtt_e A'01-fx
SubscribedAnd sworn befo me this / day of
My commission expires:
Otary Public)
2704.. LAU RA VERA j
• r.°1 /47 % Notary Public - State of Arizona ;
_ 1 maptr.nPA COUNTY !
My Comm reS Ailg 31, 2017
Following approval please return this affidavit to Maricopa County Education Service Agency

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Denise Weihe
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 5/13/2016
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for
inclusion on the next available Board agenda
V The attached item(s) have been researched to ensure that the
warrant(s) in question have not been cashed or previously re-issued.
V The original warrant(s) have had a stop payment done.
If you have any questions, please contact Denise Weihe at 602-506-7121 or
via e-mail at denise.weihe@mcesa.maricopa.gov . Approved Affidavits may
be routed back to the Superintendent of School Finance Division at 4041 N.
Central Avenue #1200, (12th Floor) Thank you.
#7 Wilson Darrin Johnson $247.05
!ED
MAY I Mb.
MARICOPA GC, Ois.ITY
CLERK BOARD OF SUPERVISORS

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Darrin Name/Claimant Johnson (1), being first sworn, upon oath deposes and says:
On or about July 09, 2015 (date)(2) a warrant/check was issued to the
above named person/entity in the amount as stated below. Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, or it was not
presented for payment within one year after the date of issuance.
Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement
warrant/check be issued to him/her in th sum of $247.05 .(3 )
Signed: (4)
(5) Subscribed and sworn to before me this 1" day of 2,:tr 20 1 < .
NOTARY PUBLIC : DUMAS
y PublIC - Arizona
My commission expires: <I-/Z , My Comm. Maricopa Expires County Oct 2,2011
July 09, 2015 (seal)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number 460002747 1,......
(if known) (6)
Original Date of Issue July 09, 2015
(if known) (7) .
Reason for original issue of Warrant/Check (8):
0 Payroll
0 For Services or Goods furnished Travel expenses
*I Other: Travel expenses
Revised S:\PROCESSES\Warrants June 2015 - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
A.R.S. 11-632 & 15-999